Outlining its high-level priorities and goals for the next five years, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) published its Strategic Plan for 2014-2018. In the Strategic Plan, OIG identified four broad goals: (i) fight fraud, waste, and abuse; (ii) promote quality, safety, and value; (iii) secure the future; and (iv) advance excellence and innovation. OIG’s strategies to accomplish each of these four goals will be of interest to health care providers and are listed below.

Promote quality of care in nursing facilities and community-based settings.

Continue to investigate prescription drug fraud.

Assess new payment and service delivery programs that are “intended to achieve value through care coordination” and evaluate “the reliability and integrity of quality, outcomes, and performance data” in connection with these programs.

Goal 3: Secure the future

Prioritize work on billing and payment errors.

Review and recommend changes to value-based payment methodologies to “maximize overall value, protect program integrity, and foster value and high performance.”

Advise “program administrators and policymakers on promoting the secure and effective use of data and technology.” In particular, OIG will focus on protecting the privacy and security of personally identifiable information and ensuring the security and integrity of electronic health records.

Goal 4: Advance excellence and innovation

Leverage technology and data analysis, such as analyzing billing patterns, to decide how to allocate OIG’s resources to uncover fraud.

Our Observations

OIG’s Strategic Plan outlines its priorities in broad brush strokes and largely repeats past plans and priorities. That is not surprising given that the OIG is feeling the pinch of sequestration: closing offices, contracting staff, and imposing internal spending limits. Nonetheless, the Strategic Plan promotes the OIG’s mission through fighting health care fraud and assessing/protecting program integrity as new health care payment and delivery models evolve.

Over the next several years, we anticipate that OIG will:

Try to flex its exclusion authority by pursuing more exclusion efforts involving individuals as opposed to entities;

Continue to examine and revise voluntary disclosure protocols and practices; and

Place less focus on quality-of-care cases, which we expect will continue to take a back seat to corporate false claims civil enforcement efforts. While OIG often prioritizes quality-of-care initiatives, these cases generally do not produce the eye-popping financial recoveries that allow OIG to promote the return on investment of its efforts.

Brian Dunphy is a Member in the firm’s Litigation and Health Law practices in the Boston office, and also is part of the firm’s Health Care Enforcement Defense Group. He focuses his practice on litigation and health care matters involving investigations and voluntary disclosures and has defended clients against allegations of false claims, whistleblower claims, and in SEC investigations and enforcement proceedings. For his commitment to pro bono work, Brian was selected to participate in the Boston Bar Association’s 2010–2011 Public Interest Leadership Program.

Associate Editors

Mintz Levin’s Health Law Practice

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